Towards an oncological resection of gall bladder cancer.

The ongoing poor results of surgery for gall bladder cancer are at least partially due to an inadequate adjustment of the current resection modalities to the spreading characteristics of the tumour. No improvement can be expected as long as inadequate resections are performed. Thorough investigations concerning different ways of tumour spread of gall bladder cancer are available in the literature. Assessment of this data demonstrates that the area of potential loco-regional tumour spread consists of the gall bladder, the liver segments IV and V, the hepatico-choledochal duct and all the lymphatic tissue in the hepatoduodenal ligament. A survey of the literature on tumour spread and extended resections, combined with the clinical experience of four of our own patients, is presented. Only en-bloc resection of this complete area as a standard procedure for gall bladder cancer stages T1NOMO-T3N1 aMO can lead to better results.